- 1 History of the syndrome
- 2 The cause of the disease
- 3 Provoking factors
- 4 The clinical picture of the disease
- 5 Pathogenesis of the disease
- 6 Diagnostics
- 7 Treatment of the disease
- 8 Prevention of “tired” syndrome
History of the syndrome
Chronic Fatigue Syndrome (CFS) was identified as an independent disease not so long ago: in 1988, scientists in the United States formulated diagnostic criteria that were repeatedly reviewed until 1994.
The reason for the isolation of this syndrome into a separate nosological unit (ICD-10 code – D 86.9) was a sudden increase in the number of patients who applied to medical institutions with similar complaints of severe fatigue and severe weakness. With a full diagnostic examination, these patients showed no signs of any diseases that could cause such a condition.
Studies of CFS were conducted in many countries of the world – in the USA, Japan, Great Britain, Russia, Germany, Australia. The lack of a clear reason for the occurrence of the disease and the existing white spots in the mechanism of the development of the syndrome suggest that the study of chronic fatigue syndrome has not yet been completed.
The disease is more susceptible to women (they get sick 3 times more often than men) from 25 to 45 years old, knowledge workers, people whose activities involve a great deal of responsibility and emotional pressure (doctors, teachers, managers, air traffic controllers). Rarely ill in childhood and old age.
The cause of the disease
There is no reliable information on why chronic fatigue syndrome develops. There are theories of its occurrence, each of which causes disagreement among doctors and researchers.
Psychiatrists put “at the head” of the primary mental disorders: neuropsychological imbalance disrupts the centers of the limbic system of the brain, which leads to changes in the endocrine, immune system.
Immunologists adhere to the version of the initial defect in the system of the protective link of T-cells and the breakdown of immunity, leading to clinical manifestations of the disease.
However, the most convincing (worth noting, not scientifically proven) is a viral or infectious theory of disease development. It is supposed that Epstein-Barr, herpes, Coxsackie, cytomegalovirus viruses are capable of provoking the onset of the disease.
This theory is supported by the fact that the debut of the syndrome often occurs after a postponed viral infection. Serological examination of the blood of patients with CFS revealed an elevated titer of antibodies to this kind of infectious agents.
Many clinical symptoms of the disease (fever, muscle pain, weakness, swollen lymph nodes, sore throat) can be explained by the infectious nature. There is a possibility that a new, not yet studied viral agent (presumably a herpesvirus family) that causes chronic fatigue syndrome exists in the body of the diseased.
The following factors become “fertile” ground for the onset of chronic fatigue syndrome.
Acute stress or persistent chronic exposure has a negative effect on the patient’s psyche, making it labile and receptive.
Loss of loved ones, severe emotional situation at home, conflicts and problems at work are situations in which people often fall and become trigger factors in launching a cascade of pathological biochemical reactions in the brain, and then throughout the body.
Physical and mental overload
Symptoms of chronic fatigue develop in an energy-depleted body. This depletion can cause long-term mental or physical debilitating stress, when the body consumes much more energy than it consumes.
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Unfavorable environmental situation
The CFS is recorded more frequently in megalopolises, ecologically unfavorable areas polluted by products of industrial production.
Scientifically confirmed the fact that hypodynamia is a factor contributing to the emergence of the syndrome. Residents of rural areas who are engaged in feasible physical labor suffer from this disease much less frequently than urban residents who travel by public transport and do not exercise.
A study was conducted in which two groups of individuals took part: one group took 2 km per day, and the second 5 km. It was proved that among those passing 5 km per day, the risk of the occurrence of CFS was almost halved.
The probability of occurrence of this pathology is higher in a patient whose close relatives suffered from CFS or had psychological disorders.
Psychological features and personality traits that are more characteristic of patients with this syndrome can be inherited: tendency to depression, self-doubt, pessimism, increased responsibility, anxiety.
Abuse of fast food, “fast” carbohydrates, refined products (and other high-calorie foods that do not contain nutrients) leads to the fact that the body loses energy, trace elements and nutrients in the amount in which they are necessary to ensure and maintain energy balance and the implementation of exchange processes at the proper level.
Energy deficiency is a major factor in the development of chronic fatigue syndrome.
Manifestations of allergies trigger a cascade of immunological reactions that create a constant tension of the immune system.
Such intensity is detected in CFS, which means that an allergy (mainly to food products, as well as to other provoking factors – dust, pet dander, plant pollen) can be considered one of the provoking factors of the disease.
Lack of sleep
Sleep less than eight hours at night and its deprivation (unregulated mode of work and rest, frequent night shifts and duties) lead to the fact that the body does not have time to recover, relax and fully relax.
Chronic foci of infection
Chronic infections of the upper respiratory tract, oral cavity weaken the immune system.
The close anatomical location of the hypothalamic-pituitary region to the nasopharynx causes an infectious-toxic effect on the hypothalamus, the highest regulatory center of the autonomic nervous system, leading to its dysfunction.
The clinical picture of the disease
Symptoms of this disease can be classified into several major groups.
The leading symptom is a feeling of loss of strength, constant fatigue.
Many patients complain of:
- Increased irritability.
- Intolerance to physical exertion.
- Bad mood, depressed.
- Fatigue and increased sleepiness during the day.
- Impairment of memory and concentration.
- Difficulty in making decisions.
- Uncertainty in their abilities.
Sleep, rest, attempts to relax do not bring relief to patients and do not level the feeling of tiredness. Impaired perception of information and the ability to concentrate leads to problems in the professional sphere, because of which the symptoms of depression and irritability increase. A “vicious circle” is being formed, to which the consultation of a specialist often helps the patient to get out.
Symptoms that “mask themselves” as somatic diseases are common:
- Muscle pain, muscle weakness.
- Sternum pain without clear localization.
- Weight loss.
- Problems on the part of the digestive tract.
There are almost all patients with a diagnosis of CFS and include the following clinical signs:
- Low-grade body temperature (within 37.2-37.4 7C).
- Swollen and sore lymph nodes.
- Pain and sore throat.
- Frequent colds.
These symptoms to a certain extent confirm the infectious theory of the development of pathology, and also serve as direct evidence of the constant intensity of immunity and the defect of its cellular element.
Pathogenesis of the disease
With the development of CFS in the body, immunological changes are observed: the growth of CD8 + cells is observed, the activity of T-killers decreases, as well as the level of immunoglobulins of certain classes. This indicates an imbalance in the immune system.
Epstein-Barr virus, which produces a specific enzyme that activates the production of interleukins 5,8,10 and tumor necrosis factor, is found in many sick patients. These substances are pro-inflammatory cytokines that help maintain elevated body temperature, leading to symptoms of intoxication.
A direct correlation has been revealed between the decrease in working capacity and the level of L-carnitine in the cells. In patients suffering from chronic fatigue syndrome, there is a clear decrease in L-carnitine. And the smaller the carnitine, the lower the performance and worse the patient’s health.
Reduced levels of cortisol in the blood, lack of serotonin, imbalance of the vegetative centers of the nervous regulation and the limbic system leads to the emergence of neuropsychiatric disorders, which are constant companions of the disease.
All changes in this pathology take place at the cellular and subcellular levels, and, like the origin of the disease, still require detailed study.
The diagnosis necessarily takes into account the large and small criteria of the CFS.
Great criteria must necessarily be present in each patient with the intended syndrome to confirm it. They include:
- Unmotivated fatigue, decrease in working capacity by at least 50% in the last 6 months.
- The absence of diseases and conditions that can lead to the above disorders.
Small criteria are the symptoms of neuropsychiatric and somatoform dysfunctions – myalgia, sore throat, low-grade fever, headaches, low mood, memory impairment, insomnia.
An important step is the differential diagnosis and “cutting off” diseases with similar symptoms (oncopathology, mental disorders, immunity disorders, tuberculosis, paraneoplastic syndromes). This requires the professionalism of the attending physician and full laboratory and instrumental diagnostics.
In the diagnosis of the disease used laboratory methods (OAK, OAM, LHC), instrumental methods (ultrasound, MRI, PET, NMR), the study of the immunogram.
The patient should be examined by the following physicians: therapist, neurologist, psychiatrist, psychologist, endocrinologist, immunologist. According to the testimony to the inspection may be attracted other narrow specialists.
Treatment of the disease
Many patients with an established diagnosis of “chronic fatigue syndrome” incorrectly interpret their condition and treat it as an ordinary overwork, therefore, treatment issues are not entirely responsible, and often from the position of “lying down – and it will pass.”
It is ineffective and even dangerous to treat the symptoms of chronic fatigue syndrome using the “sofa method”, alone at home or with folk remedies: the disease can be started.
Cure completely chronic fatigue syndrome can only be under the supervision of medical specialists. Therapy of this pathology is complex, it is selected individually by the doctor.
Great importance in the treatment is attached to the creation of a trusting atmosphere between the patient and the doctor.
It is imperative that patients observe proper nutrition, a daily regimen, and sufficient physical activity. Psychotherapy sessions, group and individual classes, swimming, exercise therapy, daily walks for 2-3 hours at an average pace, massage, and acupuncture have a good result.
Drug treatment includes taking the following drugs:
- Tricyclic antidepressants.
- Serotonin reuptake inhibitors.
- Complexes of vitamins, trace elements.
- Antiviral drugs.
The choice of a group of drugs, the method and form of administration (pills, injections), the dosage is determined by the doctor individually.
Prevention of “tired” syndrome
Disease is easier to prevent than to cure. This obvious fact is the motto in the prevention of CFS. In order to reduce the risk of developing the disease, you must adhere to the following rules:
- Healthy sleep.
- Sufficient physical activity.
- Stress prevention.
- Proper nutrition.
- Lack of bad habits.
- Positive attitude.
It is important to sanitize the foci of infection in time, monitor your well-being, pay attention not only to physical health, but also mental health. Time to seek help from a psychologist in difficult life situations.
In the prevention of chronic fatigue syndrome, psychologists pay close attention to having a hobby that brings positive emotions and satisfaction. You should find a hobby for one’s soul; it is better if it is combined with an active lifestyle: hiking, kayaking, climbing.
Animals perfectly relieve stress and have a positive effect on well-being. A pet should be made to lonely people suffering from attention deficit.
Self-realization, positive emotions, movement, full sleep – friends in the prevention of this syndrome.
The following sources were used to prepare the article:
Kalinina N. M. Chronic fatigue syndrome: approaches to diagnosis and therapy // Journal of Infection and Immunity – 2011.
Pizova N. V. Clinic, diagnosis and treatment of chronic fatigue syndrome // Journal Medical Council – 2015.